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PubMed2001

Frequency of pathogen occurrence and antimicrobial susceptibility among community-acquired respiratory tract infections in the respiratory surveillance program study: microbiology from the medical office practice environment.

Continuing problems of antimicrobial resistance have prompted the initiation of several surveillance programs. Few, if any, of these programs focus on community-acquired respiratory tract infections seen in routine office-based practices. The Respiratory Surveillance Program (RESP; 1999-2000) in 674 community-based physician office practices in the United States determined the frequency of potential bacterial pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis in patients diagnosed clinically with community-acquired pneumonia, acute exacerbations of chronic bronchitis, and sinusitis throughout all 9 US census/geographic regions. Susceptibility to the penicillins (ampicillin, penicillin), oral cephalosporins, fluoroquinolones (gatifloxacin, levofloxacin, ciprofloxacin), macrolides (erythromycin, azithromycin, clarithromycin), tetracycline, and trimethoprim/sulfamethoxazole was determined by reference methods. Patients were required to have a culturable focus of infection, and specimens were immediately sent to a reference laboratory. Among 22,689 total specimens (610 community-acquired pneumonia, 4,779 acute exacerbation of chronic bronchitis, 16,213 sinusitis, 1,087 other), H influenzae was the most commonly isolated organism from patients with community-acquired pneumonia (38%) and acute exacerbation of chronic bronchitis (35%) in all nine geographic regions. S pneumoniae was isolated in 18% of community-acquired pneumonia cases, 13% of acute exacerbation of chronic bronchitis cases, and 11% of sinusitis cases. M catarrhalis was most commonly isolated from the nasopharynx of patients with sinusitis (29%). High-level resistance to penicillin (2 microg/mL or greater; 16% overall) and the macrolides (32% to 35%) among S pneumoniae varied both with site of infection and with geographic region. The greatest resistance was observed among isolates from the nasopharynx of patients with sinusitis and from patients from the East South Central or South Atlantic regions of the United States. Although the susceptibility of H influenzae and M catarrhalis to the tested antimicrobials did not vary with the type of infection, beta-lactamase-mediated resistance to ampicillin among H influenzae ranged from 15% in New England to 32% in the East South Central region. The fluoroquinolones were highly active against these cultured isolates from community-acquired respiratory tract infection patients, with >99% of all S pneumoniae, H influenzae, and M catarrhalis strains susceptible to gatifloxacin (MIC(90), 0.5 microg/mL) and levofloxacin (MIC(90), 2 microg/mL). The extended-spectrum fluoroquinolones appear well suited for community-acquired respiratory tract infection therapy, including pathogens other than pneumococcus, H influenzae, and M catarrhalis.

Adolescent↗
PubMed1980

The appearance of cell-bound IgE in respiratory-tract epithelium after respiratory-syncytial-virus infection.

We studied the appearance of IgE in the respiratory tract in 42 infants and young children with various forms of respiratory illness after infection by respiratory syncytial virus (RSV). IgE was bound to exfoliated nasopharyngeal epithelial cells in most patients with RSV infection during the acute phase of infection, regardless of the form of illness. However, the continued presence of cell-bound IgE was more common in patients with RSV-induced bronchiolitis or asthma than in patients with mild upper-respiratory-tract illness or pneumonia due to RSV. Persistence of IgE was also apparently related to the incidence of previous episodes of wheezing in patients or their families. The production of IgE and the subsequent release of chemical mediators of bronchospasm may contribute to the pathogenesis of acute illness due to RSV; persistence of IgE in the respiratory tract may explain the recurrent episodes of wheezing that occur in many patients after RSV-induced bronchiolitis.

Antigens, Viral↗
PubMed1998

Calcified mitochondria in epithelial cells of the respiratory tract in upper respiratory thermal injury.

Multiple hematoxyphilic small granules were found in the respiratory columnar cells in smears from bronchial washings in a symptomatic boy who had suffered from extensive burns in his face and was suspected to had developed thermal injury of the upper respiratory tract. These granules proved to be immunoreactive for mitochondria antigen antibodies and to contain calcium salts after the von Kossa stain. Calcified mitochondria may represent a peculiar phenotype of thermal injury to the bronchial lining cells.

Burns↗
PubMed2000

Wheezing following lower respiratory tract infections with respiratory syncytial virus and influenza A in infancy.

We examined the incidence of subsequent wheezing in 292 children, hospitalized for influenza A or respiratory syncytial virus (RSV) lower respiratory tract infection, during two consecutive seasons (November-December, 1993 and March-April, 1995). Questionnaires concerning episodes of wheezing and known risk factors for wheezy bronchitis were mailed to parents 1 year after hospitalization. Sixty per cent of parents reported two or more episodes of wheezing following either influenza A or RSV. Hospitalization as a result of wheezing was necessary in 15% of the patients. The severity of the primary infection, as indicated by the need for treatment in the intensive care unit (ICU), was correlated with later wheezing. No additional significant risk factors predicting later wheezing could be identified.

Asthma↗
PubMed1979

[Respiratory tract diseases in coal miners. III. Effects of smoking on the rate of chronic respiratory tract diseases in coal miners].

Effects of smoking on the case rate of chronic nonspecific respiratory tract diseases in underground coal miners of two mines "A" and "B" were analysed. Work environment and miners under investigation have been thoroughly described in Part I. Smoking miners from both mines, as examined using the significance test chi 2, did not differ significantly, as regards their age and length of employment. In either mine 73.7% of miners were smokers. In both groups of miners, smoking was found to largely affect health. The chronic nonsepcific respiratory tract diseases were 13 times more frequent in smokers and 11 times in ex-smokers, as compared to non-smokers. In smokers and ex-smokers the case rate of these diseases was found to be directly proportional to the amount of cigarettes smoked daily. The higest percentage of those diseases was found in smokers and ex-smokers smoking more than 25 cigarettes a day. The prevalence of chronic non-specific respiratory tract diseases was not increasing after more than 10 years of smoking. The obturative form of the disease came to about 10% in smokers and ex-smokers from both groups; thus it was 8 times more frequent than among general populations examined. In mine "A" non-smokers, the case rate of the disease was found to be almost twice that of mine "B", which may be indicative of additional factors promoting the development of chronic nonspecific respiratory tract diseases.

Chronic Disease↗
PubMedDate not supplied

[In vitro activity of several antibiotics on pathogenic micro-organisms isolated from the lower respiratory tract].

Lower respiratory tract infections are clinically important, because of their high incidence, as well as the significant morbidity they cause. Hence the great importance to diagnose the etiology of these infections and treat the patient with selective therapy. In this study 367 bacteria isolated from lower respiratory tract were identified (253 Gram negative and 114 Gram positive) and tested towards augmentin, ceftriaxone, lomefloxacin, ciprofloxacin, ofloxacin and erythromycin. The in vitro activity of such antibiotics against the clinical isolates was compared.

Anti-Bacterial Agents↗
PubMed2003

Iron and iron-related proteins in the lower respiratory tract of patients with acute respiratory distress syndrome.

OBJECTIVE: An increased oxidative stress in the lower respiratory tract of individuals with acute respiratory distress syndrome is considered to be one mechanism of lung injury in these patients. Cell and tissue damage resulting from an oxidative stress can ultimately be the consequence of a disruption of normal iron metabolism and an increased availability of catalytically active metal. Using bronchoalveolar lavage fluid, we quantified concentrations of iron and iron-related proteins in the lower respiratory tract in patients with acute respiratory distress syndrome and healthy volunteers. DESIGN: A clinical study to quantify iron and iron-related proteins in the lower respiratory tract in patients with acute respiratory distress syndrome and healthy volunteers. PATIENTS: We studied 14 patients with acute respiratory distress syndrome and 28 healthy volunteers. MAIN RESULTS: Comparable to previous investigation, protein, albumin, and cytokine concentrations in the bronchoalveolar lavage fluid were significantly increased in acute respiratory distress syndrome patients. The concentrations of total and nonheme iron were also increased in the lavage fluid of patients. Concentrations of hemoglobin, haptoglobin, transferrin, transferrin receptor, lactoferrin, and ferritin in the bronchoalveolar lavage fluid were all significantly increased in acute respiratory distress syndrome patients. CONCLUSIONS: We conclude that bronchoalveolar lavage fluid indices reflect a disruption of normal iron metabolism in the lungs of acute respiratory distress syndrome patients. Increased concentrations of available iron in acute respiratory distress syndrome may participate in catalyzing oxidant generation destructive to the tissues of the lower respiratory tract. However, increased metal availability is also likely to elicit an increased expression of transferrin receptor, lactoferrin, and ferritin in the lower respiratory tract which will function to diminish this oxidative stress.

Adult↗
PubMed1983

Isolation of Trichomonas vaginalis from the respiratory tract of infants with respiratory disease.

Trichomonas vaginalis was isolated from the respiratory tracts of two infants with respiratory disease. Bacterial and viral cultures of tracheal aspirates and nasopharyngeal specimens did not detect bacterial pathogens or viruses; however, T vaginalis was found to be present in inoculated cell cultures. Both infants were delivered vaginally by mothers with known previous episodes of T vaginalis infection. The possibility that this organism may, on occasion, cause respiratory tract disease needs further evaluation.

Delivery, Obstetric↗
PubMedDate not supplied

The evaluation of upper respiratory tract infection symptoms to show the significance of developing a quality-of-life evaluation instrument for upper respiratory tract infections to assess respiratory disorder-related disability.

In a majority of clinical trials in upper respiratory tract infections (URTIs), it is now standard to include a measure of health-related quality of life (HRQOL) as a key outcome, and numerous clinicians are now adding QOL to routine clinical assessments. Because of this, the design of a disease-specific instrument for URTIs that has strong measurement properties and is more sensitive to minute changes is of great value in having an appropriate perception of what value patients put on their QOL and how changes in these values correlate with positive or negative progress in health. This is an attempt to show the significance and effects of URTIs on the affected patient and the potential genesis in the construction of a HRQOL evaluative tool named QOLAURTI, which, if eventually tested for interpretability with positive results, will measure fluctuations in a patient's QOL score that will correlate with minute but significant, moderate, or huge improvement or decline in a patient's QOL and also help in treating illness of URTI origin by classifying severity of illness. Relevant articles retrieved through PubMed and MEDLINE were cited to describe the impact of URTIs. Current published and available references outlining ways to construct an effective evaluative instrument that is based on the specific disease state and its impact on affected patients are employed to help construct a QOL questionnaire that could be effective in measuring the QOL of an affected patient. The construction of a potentially effective evaluative tool was achieved and is included here. However, since this tool was not tested due to inadequate numbers of test subjects and facilities required, its reliability, validity, and interpretability cannot be determined as of yet. Patients with URTIs are usually troubled by nasal symptoms and other symptoms including fatigue and headache. It can be inferred that suffering from these symptoms concomitantly can cause quite severe impairments of normal daily human protocol including physical, occupational, and social functioning and can also cause emotional distress. Because of the importance of the potential impact of these symptoms on affected individuals, a closer look into how these symptoms affect the HRQOL of an individual is important. The main goal in treating patients with URTIs is to make sure that all individual patient problems are recognized so that they can be treated properly. To achieve this, it is important to measure QOL. Research has shown that generic health-status questionnaires are able to compare burden of illness across different medical conditions but that they are not usually responsive enough to small but clinically essential changes in patients' QOL. Because of this, it is important to have a disease-specific instrument for URTIs that can measure the QOL of the affected individual. The main importance in measuring the QOL of the affected individual would be in assessing the potential effectiveness of drug therapies and treatment protocols used in treating URTIs.

Child↗
PubMed2005

Climatic factors and lower respiratory tract infection due to respiratory syncytial virus in hospitalised infants in northern Spain.

OBJECTIVE: To analyse the influence of climatic factors on the number of hospitalised infants with respiratory syncytial virus (RSV) per week. METHODS: A retrospective observational case-control study was designed enrolling infants under 2 years of age, admitted to hospital between October 1995 and June 2000 with lower respiratory tract infection due to RSV. Climatic and seasonal data were included. The week variable was used as the study unit: weeks with more than one admission for the case group and weeks without admissions for the control group. The total number of weeks excluding summer months, from June to September, was 174. RESULTS: A total of 167 infants were admitted to hospital with lower respiratory tract infection due to RSV with a peak in January and February. There was 82 weeks with one or more admissions (case group) and 92 without admissions (control group). The case group demonstrated lower levels of humidity (absolute: 5.6 +/- 1.5 vs. 6.5 +/- 1.5; p < 0.001) and lower temperature (ground level: 0.4 +/- 3.2 vs. 2.2 +/- 3.5; p < 0.001). When climatic factors were analysed in a logistic regression model, absolute humidity (p < 0.001) was an independent variable associated with a higher risk of infection. CONCLUSIONS: Low absolute humidity was independently associated with hospital admission of infants with lower respiratory tract infection due to RSV.

Case-Control Studies↗
PubMed1991

Etiology of acute lower respiratory tract infections in Gambian children: I. Acute lower respiratory tract infections in infants presenting at the hospital.

Ninety infants less than 1 year of age with pneumonia and 43 control infants were investigated for viral and chlamydial infection with the use of culture and serology and for bacterial infection with the use of blood cultures, lung aspirates, antibody assays and antigen detection procedures. One or more potential pathogens were identified in 62 (69%) cases with pneumonia and in 12 (28%) controls. Infection by respiratory viruses was identified in 42 (49%) cases and in 8 (19%) controls. Respiratory syncytial virus was the commonest pathogen identified and was found in 32 cases (37%). Bacterial infections were also common, being found in 27 (30%) cases and 3 (7%) controls, and predominantly involved Streptococcus pneumoniae (20%) or Haemophilus influenzae (11%). Bacterial infections were associated with raised white blood cell counts and were identified more often by antigen detection procedures (68%) than by culture of blood or lung aspirates (34%) or by serology (33%). Mixed viral-bacterial infections were identified in 13 cases (15%). Infection with Chlamydia trachomatis was diagnosed in 2 infants with acute lower respiratory tract infection and in 1 control infant.

Acute Disease↗
PubMed1989

Clinical manifestations of respiratory tract infections due to respiratory syncytial virus and rhinoviruses in hospitalized children.

From September 1984 to May 1986, nasopharyngeal secretions were obtained from 519 children with some form of respiratory tract infection. The nasal secretions were screened for respiratory syncytial virus (RSV), rhinoviruses, adenoviruses, parainfluenza virus types 1, 2, 3, influenza virus types A and B, and enteroviruses by tissue culture virus isolation technique and/or enzyme-linked immunosorbent assay. A uniform questionnaire gave information about age, sex, individual signs and symptoms, findings of the physical examination and clinical diagnosis of the patients. RSV was detected in 119 (23%) specimens and was thus the most frequent causative agent of respiratory infections. After RSV, rhinoviruses were the most frequently recovered pathogens accounting for 60 (12%) cases of acute respiratory disease. A comparison of the individual signs and symptoms, the findings of the physical examination and the clinical diagnosis of RSV and rhinovirus infected children revealed that there was no characteristic clinical pattern associated with either of the two viral respiratory pathogens. According to our results, rhinovirus infections were a major cause of lower respiratory tract infections in hospitalized children less than or equal to 3 years old.

Child, Preschool↗
PubMed1991

Experimental reproduction of respiratory tract disease with bovine respiratory syncytial virus.

An experiment was conducted to reproduce respiratory tract disease with bovine respiratory syncytial virus (BRSV) in one-month-old, colostrum-fed calves. The hypothesized role of viral hypersensitivity and persistent infection in the pathogenesis of BRSV pneumonia was also investigated. For BRSV inoculation a field isolate of BRSV, at the fifth passage level in cell culture, was administered by a combined respiratory tract route (intranasal and intratracheal) for four consecutive days. Four groups of calves were utilized as follows: Group I, 6 calves sham inoculated with uninfected tissue culture fluid and necropsied 21 days after the last inoculation; Group II, 6 calves inoculated with BRSV and necropsied at the time of maximal clinical response (4-6 days after the last inoculation); Group III, 6 calves inoculated with BRSV and necropsied at 21 days after the last inoculation; Group IV, 6 calves inoculated with BRSV, rechallenged with BRSV 10 days after initial exposure, and necropsied at 21 days after the initial inoculation. Clinical response was evaluated by daily monitoring of body temperature, heart rate, respiratory rate, arterial blood gas tensions, hematocrit, total protein, white blood cell count, and fibrinogen. Calves were necropsied and pulmonary surface lesions were quantitated by computer digitization. Viral pneumonia was reporduced in each principal group. Lesions were most extensive in Group II. Disease was not apparent in Group I (controls). Significant differences (p less than 0.05) in body temperature, heart rate, respiratory rate, arterial oxygen tension, and pneumonic surface area were demonstrated between control and infected calves. Results indicate that severe disease and lesions can be induced by BRSV in one-month-old calves that were colostrum-fed and seropositive to BRSV. BRSV rechallenge had minimal effect on disease progression. Based on clinical and pathological response, results did not support viral hypersensitivity or persistent infection as pathogenetic mechanisms of BRSV pneumonia.

Animals↗